Abstracts
2000 Digestive Disease Week

# 2309 Outcome of Acute Pancreatitis: 41 Years of Management at a University Hospital.
Archana Ramaswamy, Rea A. Brown, Lawrence Rosenberg, Montreal, PQ, Canada

Introduction: Acute pancreatitis remains an important surgical disease with a significant morbidity and mortality. There have been new modalities of treatment introduced since the early 1990’s, including early and repeated CT scanning, use of early endoscopic retrograde cholangiopancreatography (ERCP) and the use of somatostatin analogues. The impact of these interventions on outcome was studied. Methods: A retrospective review of 488 cases of acute pancreatitis between 1986 and 1997 was compared with similar reviews reported from our institution between 1956 and 1985 culminating in 1117 cases over 41 years. Results: There has been a shift in the etiology of the disease with a decrease in the proportion of the cases attributed to gallstones (43.0% vs 52.1%, p=0.002), as well as a decrease in the proportion secondary to alcohol (11.5% vs 21.9%, p<0.001). In contradistinction, there was an increase in cases related to ERCP (1.1% vs 8.2%, p<0.001), and in those classified as idiopathic /other (22.0% vs 34.6%, p<0.001). Overall, there was a trend towards decreased mortality in the last 11 years compared to the previous 30 year data (4.5% vs 6.6%, p=ns), with a significant change between 1986- 1990 vs 1991-1997 (6.7% vs 2.9%, p=0.04). There is still an increase in mortality based on higher Ranson’s scoring,though there has been a decrease in mortality between the 5-year periods at Ranson’s >6 (58.3% vs 21.4%, p=0.05). Conclusion: The etiology of acute pancreatitis has changed spectrum over the last 41 years at our institution. In addition to an increase in the number of hospital admissions for acute pancreatitis, for the first time, there has been a decrease in mortality in the last 5 years of the study period.